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<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
<title>Untitled Document</title>
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<body>
<table width="500" border="1">
  <tr>
    <td colspan="2" align="center"><h2>Customer Information</h2></td>
  </tr>
  <tr>
    <td width="77">Code:</td>
    <td width="107"><input type="text" name="cus_code" value="KH001" /></td>
  </tr>
  <tr>
    <td>Name:</td>
    <td><input type="text" name="cus_name" value="Ha Chi" /></td>
  </tr>
    <tr>
    <td>Email:</td>
    <td><input type="text" name="cus_dob" value="chi@gmail.com" /></td>
  </tr>
  <tr>
    <td>Address:</td>
    <td><input type="text" name="cus_address" value="Phu My Hung" /></td>
  </tr>
    <tr>
    <td>City:</td>
    <td><input type="text" name="cus_address" value="Ho CHi Minh" /></td>
  </tr>
  <tr>
    <td>Phone:</td>
    <td><input type="text" name="cus_phone" value="987654321" /></td>
  </tr>
  <tr>
    <td>Gender:</td>
    <td><input type="radio" />Mr. 
    <input type="radio" />Mrs. </td>
  </tr>
  <tr>
    <td colspan="2"><em>//message</em></td>
  </tr>
  <tr>
	<td colspan="2">
    	<input type="reset" value="Reset"/>
        <input type="button" value="Save"/>
        <input type="button" value="Exit" />    </td>
  </tr>
</table>

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